Tom Keh Jens Wang a Professional Dental Corp

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

32223 Issued in CA

Legal business name

TOM KEH JENS WANG A PROFESSIONAL DENTAL CORP

Practice address

1408 S San Gabriel Blvd
San Gabriel, CA 91776-3603

Phone

(626) 572-7211

NPI assigned

Apr 4, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tom K J Wang, DDS

Title

President

Phone

(626) 572-7211

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edward Wang

  • Dentist
  • San Gabriel, CA
  • NPI 1093530073
  NPD (past)
• Kehjenq Wang, DDS

  • General Practice Dentistry
  • San Gabriel, CA
  • NPI 1760607626
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699897223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 S SAN GABRIEL BLVD",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917763603",
            "telephone_number": "626-572-7211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1408 S SAN GABRIEL BLVD",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917763603",
            "telephone_number": "626-572-7211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOM KEH JENS WANG A PROFESSIONAL DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WANG",
        "authorized_official_first_name": "TOM",
        "authorized_official_middle_name": "K J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-572-7211",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "32223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in San Gabriel, CA
• Providers in San Gabriel, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.